摘要： 目的 探究立体定向电极进行皮质功能电刺激诱发恐惧情绪反应的神经网络机制。方法与结果 选择2021 年1 月至2022 年6 月经首都医科大学三博脑科医院明确诊断并行立体定向电极植入术的耐药性癫痫患者共20 例，其中7 例（35%）共计75 个获得重建的电极触点［9.66%（75/776）］诱发出恐惧情绪反应，主要分布于颞叶［45.33%（34/75）］、岛叶［32%（24/75）］和扣带回［13.33%（10/75）］；根据“种子和发现”计算方法，诱发恐惧情绪反应电极触点在9 个通用脑网络（听觉网络、左侧执行控制网络、右侧执行控制网络、感觉运动网络、视空间网络、背侧默认模式网络、高级视觉网络、后侧突显网络和初级视觉网络）出现的概率以背侧默认模式网络最高，占 84%（63/75）；检索 Neurosynth 数据库获得诱发恐惧情绪反应电极触点的全脑功能连接值，计算脑网络内功能连接值与脑网络外功能连接值的差异，发现诱发恐惧情绪反应电极触点与背侧默认模式网络匹配度最高，其次为后侧突显网络。结论 基于立体定向脑电图记录，皮质功能电刺激诱发出的恐惧情绪反应主要与背侧默认模式网络相关；海马、岛叶和扣带回是恐惧情绪反应的重要网络节点，提示电刺激诱发的恐惧情绪反应与后天条件习得恐惧之间存在共享神经回路。

关键词: 恐惧, 立体定位技术, 脑电描记术, 神经网

Abstract: Objective To investigate the neural network mechanism of fear functional electrical stimulation with stereotactic electrodes. Methods and Results A total of 20 patients with intractable epilepsy who were diagnosed and underwent stereotactic electrode implantation in Sanbo Brain Hospital of Capital Medical University from January 2021 to June 2022 were selected. Among them, 7 patients (35%) received 75 reconstructed electrode contacts [9.66% (75/776)] to induce fear emotional response. They were mainly distributed in temporal lobe [45.33% (34/75)], insula lobe [32% (24/75)] and cingulate gyrus [13.33% (10/75)]. According to the "seed and discovery" calculation method, the occurrence probability of evoked fear response electrode contacts in 9 general brain networks (auditory, left executive control, right executive control, sensorimotor, visuospatial, dorsal default mode, advanced vision, posterior salience and primary vision) was the highest in the dorsal default mode network, accounting for 84% (63/75). The whole brain functional connection values of the fear-inducing electrode contacts were retrieved from the neurosynth database, and the differences between the in-brain and out-brain functional connection values were calculated. It was found that the matching degree between the fear-inducing electrode contacts and the dorsal default mode network was the highest, followed by the posterior prominence network. Conclusions Based on stereo-electroencephalography (EEG), the fear response induced by cortical functional electrical stimulation was mainly related to the dorsal default mode network. The hippocampus, insula and cingulate gyrus are important network nodes of fear response. It is suggested that there is a shared neural circuit between the fear response induced by electrical stimulation and the fear experience acquired through conditioning.

Key words: Fear, Stereotaxic techniques, Electroencephalography, Nerve net